Integrated Alcohol Use Disorder and Liver Disease Management

Hanna Blaney; Adelina Horhat; Abdulmalik Saleem; Gerald S. Winder; Jessica Mellinger; Juan P. Arab

doi:10.1055/a-2717-3496

Seminars in Liver Disease, Inhaltsverzeichnis

Semin Liver Dis
DOI: 10.1055/a-2717-3496

Review Article

Integrated Alcohol Use Disorder and Liver Disease Management

Autoren

Hanna Blaney ^*

¹Medstar Transplant Hepatology Institute, MedStar Georgetown University Hospital, Washington, District of Columbia
Adelina Horhat ^*

²Department of Hepatology, Paris-Est Créteil University, Hôpital Henri-Mondor, Assistance Publique Hôpitaux de Paris, Paris, France
Abdulmalik Saleem

³Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan
Gerald S. Winder

⁴Department of Psychiatry and Behavioral Medicine, Henry Ford Health, Detroit, Michigan
Jessica Mellinger

⁵Division of Gastroenterology and Hepatology, Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan
Juan P. Arab

⁶Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia

⁷Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile

Abstract

Alcohol-associated liver disease (ALD) is a leading cause of liver disease worldwide, caused by hazardous alcohol use. Many patients with ALD also have alcohol use disorder (AUD), a chronic mental health condition characterized by a cluster of behavioral, cognitive, and physiological symptoms that indicate continued alcohol use despite significant alcohol-related problems. Comprehensive care of ALD often requires treatment of AUD, and evidence has demonstrated that treating the latter improves patient outcomes. However, only a minority of patients with AUD/ALD receive treatment. Integrative care models where hepatologists work alongside AUD specialists have been developed. These partnerships have been associated with improved outcomes, including decreased rates of return to alcohol use, decreased healthcare utilization, and even improved mortality. We review the epidemiology, diagnosis, and treatment of AUD and ALD, examples of successful integrated care models, and outcomes. We also discuss knowledge gaps and areas where future research is needed, including the role of integrated care in the peri-transplantation period for ALD, harm reduction approaches, and the need for efforts to support collaboration for integrative care. In conclusion, the dual pathologies of AUD and ALD necessitate multidisciplinary care, and integrated care models have been shown to be both feasible and effective.

Keywords

alcohol-associated liver disease - alcohol use disorder - integrated care

Volltext

Referenzen

References
1 Devarbhavi H, Asrani SK, Arab JP, Nartey YA, Pose E, Kamath PS. Global burden of liver disease: 2023 update. J Hepatol 2023; 79 (02) 516-537
2 Beresford TP. Predictive factors for alcoholic relapse in the selection of alcohol-dependent persons for hepatic transplant. Liver Transpl Surg 1997; 3 (03) 280-291
3 Llamosas-Falcón L, Probst C, Buckley C. et al. Sex-specific association between alcohol consumption and liver cirrhosis: an updated systematic review and meta-analysis. Front Gastroenterol (Lausanne) 2022; 1: 1005729
4 Roerecke M, Vafaei A, Hasan OSM. et al. Alcohol consumption and risk of liver cirrhosis: a systematic review and meta-analysis. Am J Gastroenterol 2019; 114 (10) 1574-1586
5 Hofer BS, Simbrunner B, Hartl L. et al. Alcohol abstinence improves prognosis across all stages of portal hypertension in alcohol-related cirrhosis. Clin Gastroenterol Hepatol 2023; 21 (09) 2308-2317.e7
6 Blaney H, Díaz LA, Li N. et al. Global differences in the management of alcohol-associated hepatitis. Lancet Gastroenterol Hepatol 2024; 9 (11) 972-974
7 Ramirez-Cadiz C, Blaney H, Kubanek N. et al. Review article: current indications and selection criteria for early liver transplantation in severe alcohol-associated hepatitis. Aliment Pharmacol Ther 2024; 59 (09) 1049-1061
8 MacKillop J, Agabio R, Feldstein Ewing SW. et al. Hazardous drinking and alcohol use disorders. Nat Rev Dis Primers 2022; 8 (01) 80
9 Carvalho AF, Heilig M, Perez A, Probst C, Rehm J. Alcohol use disorders. Lancet 2019; 394 (10200): 781-792
10 Ghosh A, Singh P, Das N, Pandit PM, Das S, Sarkar S. Efficacy of brief intervention for harmful and hazardous alcohol use: a systematic review and meta-analysis of studies from low middle-income countries. Addiction 2022; 117 (03) 545-558
11 Elzerbi C, Donoghue K, Drummond C. A comparison of the efficacy of brief interventions to reduce hazardous and harmful alcohol consumption between European and non-European countries: a systematic review and meta-analysis of randomized controlled trials. Addiction 2015; 110 (07) 1082-1091
12 Ray LA, Meredith LR, Kiluk BD, Walthers J, Carroll KM, Magill M. Combined pharmacotherapy and cognitive behavioral therapy for adults with alcohol or substance use disorders: a systematic review and meta-analysis. JAMA Netw Open 2020; 3 (06) e208279
13 Jophlin LL, Singal AK, Bataller R. et al. ACG clinical guideline: Alcohol-associated liver disease. Am J Gastroenterol 2024; 119 (01) 30-54
14 Louvet A, Labreuche J, Artru F. et al. Main drivers of outcome differ between short term and long term in severe alcoholic hepatitis: a prospective study. Hepatology 2017; 66 (05) 1464-1473
15 Rice JP, Eickhoff J, Agni R, Ghufran A, Brahmbhatt R, Lucey MR. Abusive drinking after liver transplantation is associated with allograft loss and advanced allograft fibrosis. Liver Transpl 2013; 19 (12) 1377-1386
16 Daniel J, Dumortier J, Del Bello A. et al. Integrating an addiction team into the management of patients transplanted for alcohol-associated liver disease reduces the risk of severe relapse. JHEP Rep Innov Hepatol 2023; 5 (10) 100832
17 Pfitzmann R, Schwenzer J, Rayes N, Seehofer D, Neuhaus R, Nüssler NC. Long-term survival and predictors of relapse after orthotopic liver transplantation for alcoholic liver disease. Liver Transpl 2007; 13 (02) 197-205
18 Rogal S, Youk A, Zhang H. et al. Impact of alcohol use disorder treatment on clinical outcomes among patients with cirrhosis. Hepatology 2020; 71 (06) 2080-2092
19 Blaney H, Winder GS, Liangpunsakul S. Enhancing alcohol use disorder care in alcohol-associated liver disease: patient perspectives and systemic barriers. Alcohol Clin Exp Res (Hoboken) 2024; 48 (11) 2000-2003
20 Im GY, Mellinger JL, Winters A. et al. Provider attitudes and practices for alcohol screening, treatment, and education in patients with liver disease: a survey from the American Association for the study of liver diseases alcohol-associated liver disease special interest group. Clin Gastroenterol Hepatol 2021; 19 (11) 2407-2416.e8
21 Caputo F, Domenicali M, Bernardi M. Diagnosis and treatment of alcohol use disorder in patients with end-stage alcoholic liver disease. Hepatology 2019; 70 (01) 410-417
22 Lucey MR, Singal AK. Integrated treatment of alcohol use disorder in patients with alcohol-associated liver disease: an evolving story. Hepatology 2020; 71 (06) 1891-1893
23 World Health Organization. Global Status Report on Alcohol and Health and Treatment of Substance Use Disorders. World Health Organization; 2024
24 Alcohol, heavy episodic drinking (population) past 30 days. Accessed January 11, 2025 at: https://www.who.int/data/gho/indicator-metadata-registry/imr-details/459#:~:text=Heavy%20episodic%20drinking%20is%20defined,to%206%20standard%20alcoholic%20drinks
25 Manthey J, Shield KD, Rylett M, Hasan OSM, Probst C, Rehm J. Global alcohol exposure between 1990 and 2017 and forecasts until 2030: a modelling study. Lancet 2019; 393 (10190): 2493-2502
26 2023 NSDUH Detailed Tables. Accessed November 13, 2024 at: https://www.samhsa.gov/data/report/2023-nsduh-detailed-tables
27 Niu X, Zhu L, Xu Y. et al. Global prevalence, incidence, and outcomes of alcohol related liver diseases: a systematic review and meta-analysis. BMC Public Health 2023; 23 (01) 859
28 Amonker S, Houshmand A, Hinkson A, Rowe I, Parker R. Prevalence of alcohol-associated liver disease: a systematic review and meta-analysis. Hepatol Commun 2023; 7 (05) e0133
29 GBD 2017 Cirrhosis Collaborators. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol 2020; 5 (03) 245-266
30 Cholankeril G, Ahmed A. Alcoholic liver disease replaces hepatitis C virus infection as the leading indication for liver transplantation in the United States. Clin Gastroenterol Hepatol 2018; 16 (08) 1356-1358
31 Deutsch-Link S, Jiang Y, Peery AF, Barritt AS, Bataller R, Moon AM. Alcohol-associated liver disease mortality increased from 2017 to 2020 and accelerated during the COVID-19 pandemic. Clin Gastroenterol Hepatol 2022; 20 (09) 2142-2144.e2
32 Cotter TG, Mitchell MC, Patel MJ. et al. Racial and ethnic disparities in liver transplantation for alcohol-associated liver diseases in the United States. Transplantation 2024; 108 (01) 225-234
33 Singal AK, Arsalan A, Dunn W. et al. Alcohol-associated liver disease in the United States is associated with severe forms of disease among young, females and Hispanics. Aliment Pharmacol Ther 2021; 54 (04) 451-461
34 Anouti A, Mellinger JL. The changing epidemiology of alcohol-associated liver disease: gender, race, and risk factors. Semin Liver Dis 2023; 43 (01) 50-59
35 Carlini LE, Fernandez AC, Mellinger JL. Sex and gender in alcohol use disorder and alcohol-associated liver disease in the United States: a narrative review. Hepatology 2024;
36 Danpanichkul P, Ng CH, Muthiah M. et al. From shadows to spotlight: exploring the escalating burden of alcohol-associated liver disease and alcohol use disorder in young women. Am J Gastroenterol 2024; 119 (05) 893-909
37 Askgaard G, Fleming KM, Crooks C. et al. Socioeconomic inequalities in the incidence of alcohol-related liver disease: a nationwide Danish study. Lancet Reg Health Eur 2021; 8: 100172
38 Ahn JC, Wi CI, Buryska S. et al. Disproportionate increases in alcohol-associated hepatitis incidence in women and individuals of low socioeconomic status: a population-based study using the Rochester epidemiology project database. Hepatol Commun 2023; 7 (06) e0160
39 Chuncharunee L, Yamashiki N, Thakkinstian A, Sobhonslidsuk A. Alcohol relapse and its predictors after liver transplantation for alcoholic liver disease: a systematic review and meta-analysis. BMC Gastroenterol 2019; 19 (01) 150
40 Jinjuvadia R, Jinjuvadia C, Puangsricharoen P, Chalasani N, Crabb DW, Liangpunsakul S. Translational Research and Evolving Alcoholic Hepatitis Treatment Consortium. Concomitant psychiatric and nonalcohol-related substance use disorders among hospitalized patients with alcoholic liver disease in the United States. Alcohol Clin Exp Res 2018; 42 (02) 397-402
41 Stinson FS, Grant BF, Dawson DA, Ruan WJ, Huang B, Saha T. Comorbidity between DSM-IV alcohol and specific drug use disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug Alcohol Depend 2005; 80 (01) 105-116
42 DiMartini A, Day N, Dew MA. et al. Alcohol consumption patterns and predictors of use following liver transplantation for alcoholic liver disease. Liver Transpl 2006; 12 (05) 813-820
43 Rogal S, Shenai N, Kruckenberg K, Rosenberger E, Dew MA, DiMartini A. Post-transplant outcomes of persons receiving a liver graft for alcoholic liver disease. Alcohol Alcohol 2018; 53 (02) 157-165
44 Schroeder M, Pedersen M, Petrasek J, Grant L. Outcomes following liver transplant for alcohol-associated liver disease: comparing alcohol-associated hepatitis and cirrhosis. Hepatol Commun 2023; 7 (05) e0132
45 Dumortier J, Dharancy S, Cannesson A. et al. Recurrent alcoholic cirrhosis in severe alcoholic relapse after liver transplantation: a frequent and serious complication. Am J Gastroenterol 2015; 110 (08) 1160-1166 , quiz 1167
46 Lee BP, Dodge JL, Terrault NA. Excess mortality after liver transplantation in young women with alcohol-associated liver disease. Am J Gastroenterol 2021; 116 (03) 551-559
47 Fipps DC, Meyer R, Woods J. et al. Clinical utility and impact of phosphatidylethanol testing in liver transplantation evaluations. J Acad Consult Liaison Psychiatry 2024; 65 (02) 157-166
48 Midanik LT. Validity of self-reported alcohol use: a literature review and assessment. Br J Addict 1988; 83 (09) 1019-1030
49 Webzell I, Ball D, Bell J. et al. Substance use by liver transplant candidates: an anonymous urinalysis study. Liver Transpl 2011; 17 (10) 1200-1204
50 Office of Disease Prevention, U. S. Department of Health. Dietary Guidelines for Americans, 2015–2020 Eighth Edition. 2020
51 Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction 1993; 88 (06) 791-804
52 Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. . Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test.
53 Smith PC, Schmidt SM, Allensworth-Davies D, Saitz R. Primary care validation of a single-question alcohol screening test. J Gen Intern Med 2009; 24 (07) 783-788
54 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). American Psychiatric Publishing; 2021
55 Kroenke K, Spitzer RL, Williams JBW. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care 2003; 41 (11) 1284-1292
56 Jordan P, Shedden-Mora MC, Löwe B. Psychometric analysis of the generalized anxiety disorder scale (GAD-7) in primary care using modern item response theory. PLoS One 2017; 12 (08) e0182162
57 Viel G, Boscolo-Berto R, Cecchetto G, Fais P, Nalesso A, Ferrara SD. Phosphatidylethanol in blood as a marker of chronic alcohol use: a systematic review and meta-analysis. Int J Mol Sci 2012; 13 (11) 14788-14812
58 MacSween RN, Burt AD. Histologic spectrum of alcoholic liver disease. Semin Liver Dis 1986; 6 (03) 221-232
59 Sterling RK, Lissen E, Clumeck N. et al; APRICOT Clinical Investigators. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology 2006; 43 (06) 1317-1325
60 Lieber CS, Weiss DG, Morgan TR, Paronetto F. Aspartate aminotransferase to platelet ratio index in patients with alcoholic liver fibrosis. Am J Gastroenterol 2006; 101 (07) 1500-1508
61 Thiele M, Madsen BS, Hansen JF, Detlefsen S, Antonsen S, Krag A. Accuracy of the enhanced liver fibrosis test vs fibrotest, elastography, and indirect markers in detection of advanced fibrosis in patients with alcoholic liver disease. Gastroenterology 2018; 154 (05) 1369-1379
62 Nguyen-Khac E, Chatelain D, Tramier B. et al. Assessment of asymptomatic liver fibrosis in alcoholic patients using fibroscan: prospective comparison with seven non-invasive laboratory tests. Aliment Pharmacol Ther 2008; 28 (10) 1188-1198
63 Voican CS, Louvet A, Trabut JB. et al. Transient elastography alone and in combination with FibroTest for the diagnosis of hepatic fibrosis in alcoholic liver disease. Liver Int 2017; 37 (11) 1697-1705
64 Avitabile E, Gratacós-Ginès J, Pérez-Guasch M. et al. Liver fibrosis screening increases alcohol abstinence. JHEP Rep Innov Hepatol 2024; 6 (10) 101165
65 Orgill A, Jew MH, Soltani M. et al. Early detection of liver disease in patients with alcohol use disorder improves long-term abstinence. Alcohol Alcohol 2024; 59 (06) agae074
66 Blaney HL, Khalid MB, Yang AH. et al. Hepatology consultation is associated with decreased early return to alcohol use after discharge from an inpatient alcohol use disorder treatment program. Hepatol Commun 2024; 8 (05) e0414
67 Tapper EB, Goldberg D, Parikh ND. et al; LCN Study Group. The liver cirrhosis network cohort study: cirrhosis definition, study population, and endpoints. Am J Gastroenterol 2025; 120 (03) 570-575
68 Wiesner R, Edwards E, Freeman R. et al; United Network for Organ Sharing Liver Disease Severity Score Committee. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology 2003; 124 (01) 91-96
69 Crabb DW, Bataller R, Chalasani NP. et al; NIAAA Alcoholic Hepatitis Consortia. Standard definitions and common data elements for clinical trials in patients with alcoholic hepatitis: recommendation from the NIAAA alcoholic hepatitis consortia. Gastroenterology 2016; 150 (04) 785-790
70 Louvet A, Trabut JB, Moreno C. et al; for the Groupe collaboratif AFEF-SFA Maladie du foie liée à l'alcool. Management of alcohol-related liver disease: the French Association for the study of the liver and the French Alcohol Society clinical guidelines. Liver Int 2022; 42 (06) 1330-1343
71 Maddrey WC, Boitnott JK, Bedine MS, Weber Jr FL, Mezey E, White Jr RI. Corticosteroid therapy of alcoholic hepatitis. Gastroenterology 1978; 75 (02) 193-199
72 Arab JP, Díaz LA, Baeza N. et al. Identification of optimal therapeutic window for steroid use in severe alcohol-associated hepatitis: a worldwide study. J Hepatol 2021; 75 (05) 1026-1033
73 Thursz MR, Richardson P, Allison M. et al; STOPAH Trial. Prednisolone or pentoxifylline for alcoholic hepatitis. N Engl J Med 2015; 372 (17) 1619-1628
74 Blaney H, Tapper EB. Steroid use in alcohol-associated hepatitis: a history. Clin Liver Dis (Hoboken) 2023; 21 (05) 143-146
75 Ceci FM, Francati S, Ferraguti G. et al. Behavioral dysregulations by chronic alcohol abuse. Motivational enhancement therapy and cognitive behavioral therapy outcomes. Riv Psichiatr 2022; 57 (01) 1-9
76 McHugh RK, Hearon BA, Otto MW. Cognitive behavioral therapy for substance use disorders. Psychiatr Clin North Am 2010; 33 (03) 511-525
77 Kelly JF, Abry A, Ferri M, Humphreys K. Alcoholics Anonymous and 12-step facilitation treatments for alcohol use disorder: a distillation of a 2020 Cochrane review for clinicians and policy makers. Alcohol Alcohol 2020; 55 (06) 641-651
78 Leggio L, Lee MR. Treatment of alcohol use disorder in patients with alcoholic liver disease. Am J Med 2017; 130 (02) 124-134
79 Gopalakrishna H, Ghabril M, Gu J. et al; Drug-Induced Liver Injury Network. Drug-induced liver injury due to medications for alcohol use disorder: results from the DILIN prospective study. J Addict Med 2025; 19 (03) 314-321
80 Witkiewitz K, Saville K, Hamreus K. Acamprosate for treatment of alcohol dependence: mechanisms, efficacy, and clinical utility. Ther Clin Risk Manag 2012; 8: 45-53
81 Anton RF, Schacht JP, Book SW. Pharmacologic treatment of alcoholism. Handb Clin Neurol 2014; 125: 527-542
82 Pettinati HM, Anton RF, Willenbring ML. The COMBINE study-: an overview of the largest pharmacotherapy study to date for treating alcohol dependence. Psychiatry (Edgmont) 2006; 3 (10) 36-39
83 Thompson R, Taddei T, Kaplan D, Rabiee A. Safety of naltrexone in patients with cirrhosis. JHEP Rep Innov Hepatol 2024; 6 (07) 101095
84 Ayyala D, Bottyan T, Tien C. et al. Naltrexone for alcohol use disorder: hepatic safety in patients with and without liver disease. Hepatol Commun 2022; 6 (12) 3433-3442
85 Addolorato G, Leggio L, Ferrulli A. et al. Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis: randomised, double-blind controlled study. Lancet 2007; 370 (9603) 1915-1922
86 Vannier AGL, Shay JES, Fomin V. et al. Incidence and progression of alcohol-associated liver disease after medical therapy for alcohol use disorder. JAMA Netw Open 2022; 5 (05) e2213014
87 Anton RF, O'Malley SS, Ciraulo DA. et al; COMBINE Study Research Group. Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. JAMA 2006; 295 (17) 2003-2017
88 Magill M, Ray LA. Cognitive-behavioral treatment with adult alcohol and illicit drug users: a meta-analysis of randomized controlled trials. J Stud Alcohol Drugs 2009; 70 (04) 516-527
89 Al-Azzawi Y, Albo B, Fasullo M. et al. Sarcopenia is associated with longer hospital stay and multiorgan dysfunction in alcoholic hepatitis. Eur J Gastroenterol Hepatol 2020; 32 (06) 733-738
90 Patek Jr AJ, Post J. et al. Dietary treatment of cirrhosis of the liver; results in 124 patients observed during a 10 year period. J Am Med Assoc 1948; 138 (08) 543-549
91 Moore KP, Wong F, Gines P. et al. The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club. Hepatology 2003; 38 (01) 258-266
92 Kawaguchi T, Kawaguchi A, Hashida R. et al. Resistance exercise in combination with aerobic exercise reduces the incidence of serious events in patients with liver cirrhosis: a meta-analysis of randomized controlled trials. J Gastroenterol 2024; 59 (03) 216-228
93 Prentis JM, Manas DMD, Trenell MI, Hudson M, Jones DJ, Snowden CP. Submaximal cardiopulmonary exercise testing predicts 90-day survival after liver transplantation. Liver Transpl 2012; 18 (02) 152-159
94 Jones JC, Coombes JS, Macdonald GA. Exercise capacity and muscle strength in patients with cirrhosis. Liver Transpl 2012; 18 (02) 146-151
95 Zenith L, Meena N, Ramadi A. et al. Eight weeks of exercise training increases aerobic capacity and muscle mass and reduces fatigue in patients with cirrhosis. Clin Gastroenterol Hepatol 2014; 12 (11) 1920-6.e2
96 Burns L, Teesson M. Findings from the Australian National Survey of Mental Health and Well Being. Alcohol use disorders comorbid with anxiety, depression and drug use disorders. Drug Alcohol Depend 2002; 68 (03) 299-307
97 Bertha M, Choi G, Mellinger J. Diagnosis and treatment of alcohol-associated liver disease: a patient-friendly summary of the 2019 AASLD guidelines. Clin Liver Dis (Hoboken) 2021; 17 (06) 418-423
98 European Association for the Study of the Liver. EASL clinical practice guidelines: management of alcohol-related liver disease. J Hepatol 2018; 69 (01) 154-181
99 Arab JP, Roblero JP, Altamirano J. et al. Alcohol-related liver disease: clinical practice guidelines by the Latin American Association for the study of the liver (ALEH). Ann Hepatol 2019; 18 (03) 518-535
100 Addolorato G, Abenavoli L, Dallio M. et al. Alcohol associated liver disease 2020: a clinical practice guideline by the Italian Association for the study of the liver (AISF). Dig Liver Dis 2020; 52 (04) 374-391
101 Khan A, Tansel A, White DL. et al. Efficacy of psychosocial interventions in inducing and maintaining alcohol abstinence in patients with chronic liver disease: a systematic review. Clin Gastroenterol Hepatol 2016; 14 (02) 191-202.e1 , 4, quiz e20
102 Elfeki MA, Abdallah MA, Leggio L, Singal AK. Simultaneous management of alcohol use disorder and liver disease: a systematic review and meta-analysis. J Addict Med 2023; 17 (02) e119-e128
103 Mellinger JL, Winder GS, Fernandez AC. et al. Feasibility and early experience of a novel multidisciplinary alcohol-associated liver disease clinic. J Subst Abuse Treat 2021; 130: 108396
104 Addolorato G, Mirijello A, Leggio L. et al; Gemelli OLT Group. Liver transplantation in alcoholic patients: impact of an alcohol addiction unit within a liver transplant center. Alcohol Clin Exp Res 2013; 37 (09) 1601-1608
105 Moriarty KJ. Alcohol care teams: where are we now?. Frontline Gastroenterol 2019; 11 (04) 293-302
106 Hughes NR, Houghton N, Nadeem H. et al. Salford alcohol assertive outreach team: a new model for reducing alcohol-related admissions. Frontline Gastroenterol 2013; 4 (02) 130-134
107 Currie C, Davies A, Ariti C, Bardsley M. The impact of alcohol care teams on emergency secondary care use following a diagnosis of alcoholic liver disease - a national cohort study. BMC Public Health 2016; 16: 685
108 Fomin V, Marshall C, Tsai S, Goodman R, Schaefer E, Luther J. Creation of an inpatient alcohol liver service improves early liver disease detection in patients with alcohol use disorder. Clin Gastroenterol Hepatol 2023; 21 (06) 1646-1648
109 Mellinger JL, Fernandez A, Shedden K. et al. Gender disparities in alcohol use disorder treatment among privately insured patients with alcohol-associated cirrhosis. Alcohol Clin Exp Res 2019; 43 (02) 334-341
110 McNeely J, Schatz D, Olfson M, Appleton N, Williams AR. How physician workforce shortages are hampering the response to the opioid crisis. Psychiatr Serv 2022; 73 (05) 547-554
111 Han X, Li H, Tang YL, Palfrey J, Zhu J. The association of state-level drug and opioid overdose deaths with the capacity of behavioural health professionals in the United States. Health Soc Care Community 2022; 30 (06) e4585-e4593
112 Jackson JE, Doescher MP, Hart LG. Problem drinking: rural and urban trends in America, 1995/1997 to 2003. Prev Med 2006; 43 (02) 122-124
113 Raver E, Retchin SM, Li Y, Carlo AD, Xu WY. Rural-urban differences in out-of-network treatment initiation and engagement rates for substance use disorders. Health Serv Res 2024; 59 (05) e14299
114 Henson JB, Wegermann K, Patel YA, Wilder JM, Muir AJ. Access to technology to support telehealth in areas without specialty care for liver disease. Hepatology 2023; 77 (01) 176-185
115 Mintz CM, Hartz SM, Fisher SL. et al. A cascade of care for alcohol use disorder: using 2015-2019 National Survey on Drug Use and Health data to identify gaps in past 12-month care. Alcohol Clin Exp Res 2021; 45 (06) 1276-1286
116 Singal AK, Leggio L, DiMartini A. Alcohol use disorder in alcohol-associated liver disease: two sides of the same coin. Liver Transpl 2024; 30 (02) 200-212
117 DiMartini AF, Leggio L, Singal AK. Barriers to the management of alcohol use disorder and alcohol-associated liver disease: strategies to implement integrated care models. Lancet Gastroenterol Hepatol 2022; 7 (02) 186-195
118 Lékó AH, Leggio L. Barriers to alcohol use disorder treatment in patients with alcohol-associated liver disease. Clin Liver Dis 2024; 28 (04) 779-791
119 Presky J, Webzell I, Murrells T, Heaton N, Lau-Walker M. Understanding alcohol-related liver disease patients' illness beliefs and views about their medicine. Br J Nurs 2018; 27 (13) 730-736
120 Keyes KM, Hatzenbuehler ML, McLaughlin KA. et al. Stigma and treatment for alcohol disorders in the United States. Am J Epidemiol 2010; 172 (12) 1364-1372
121 Schomerus G, Leonhard A, Manthey J. et al. The stigma of alcohol-related liver disease and its impact on healthcare. J Hepatol 2022; 77 (02) 516-524
122 Kim D, Manikat R, Wijarnpreecha K, Ahmed A. Financial hardship and cost-related nonadherence to medication in patients with liver disease in the United States. Aliment Pharmacol Ther 2024; 60 (04) 492-502
123 Barritt IV AS, Jiang Y, Schmidt M, Hayashi PH, Bataller R. Charges for alcoholic cirrhosis exceed all other etiologies of cirrhosis combined: a national and state inpatient survey analysis. Dig Dis Sci 2019; 64 (06) 1460-1469
124 Mellinger JL, Scott Winder G, DeJonckheere M. et al. Misconceptions, preferences and barriers to alcohol use disorder treatment in alcohol-related cirrhosis. J Subst Abuse Treat 2018; 91: 20-27
125 Hemrage S, Parkin S, Kalk N, Shah N, Deluca P, Drummond C. Treatment engagement in comorbid alcohol use disorder and alcohol-related liver disease: a qualitative exploration of barriers and facilitators with service users. Alcohol Clin Exp Res (Hoboken) 2024; 48 (10) 1965-1978
126 O'Connor PG, Nyquist JG, McLellan AT. Integrating addiction medicine into graduate medical education in primary care: the time has come. Ann Intern Med 2011; 154 (01) 56-59
127 Windish DM, Catalanotti JS, Zaas A, Kisielewski M, Moriarty JP. Training in safe opioid prescribing and treatment of opioid use disorder in internal medicine residencies: A national survey of Program Directors. J Gen Intern Med 2022; 37 (11) 2650-2660
128 Chan CA, Windish DM. A survey of motivational interviewing training experiences among internal medicine residents. Patient Educ Couns 2023; 112 (107738): 107738
129 Rodrigue JR, Hanto DW, Curry MP. Substance abuse treatment and its association with relapse to alcohol use after liver transplantation. Liver Transpl 2013; 19 (12) 1387-1395
130 Winder GS, Fernandez AC, Mellinger JL. Integrated care of alcohol-related liver disease. J Clin Exp Hepatol 2022; 12 (04) 1069-1082
131 Gananandan K, Kazankov K, Tapper EB, Mookerjee RP. The new digital era in decompensated cirrhosis. Lancet Digit Health 2025; 7 (01) e54-e63
132 Goswami A, Weinberg E, Coraluzzi L. et al. A tailored virtual program for alcohol use disorder treatment among liver transplant candidates and recipients is feasible and associated with lower post-transplant relapse. Clin Transplant 2024; 38 (07) e15381
133 Maremmani I, Cibin M, Pani PP, Rossi A, Turchetti G. Harm reduction as “continuum care” in alcohol abuse disorder. Int J Environ Res Public Health 2015; 12 (11) 14828-14841
134 Díaz LA, Fuentes-López E, Idalsoaga F. et al. Association between public health policies on alcohol and worldwide cancer, liver disease and cardiovascular disease outcomes. J Hepatol 2024; 80 (03) 409-418
135 Díaz LA, Idalsoaga F, Fuentes-López E. et al. Impact of public health policies on alcohol-associated liver disease in Latin America: an ecological multinational study. Hepatology 2021; 74 (05) 2478-2490
136 Wyper GMA, Mackay DF, Fraser C. et al. Evaluating the impact of alcohol minimum unit pricing on deaths and hospitalisations in Scotland: a controlled interrupted time series study. Lancet 2023; 401 (10385): 1361-1370